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Holiday Toy Safety

There’s nothing quite like the face of a child unwrapping their gifts on Christmas morning. Whether it’s a new bike or a favorite doll, toys are on every child’s wish list. As parents, we have just as much fun shopping for the perfect gift! But before you run to the toy store, you’ll want to be sure the toys you buy are safe for your child. Every year thousands of children are treated in hospital emergency rooms for toy related injuries.

In order to keep kids safe, you should always ask yourself:

1 – Is this toy safe?

Choking is a particular risk for children three and younger, because they tend to put objects in their mouths. Dr. Terri Coco is an emergency room physician at Children’s of Alabama and an injury prevention expert. She says a good rule of thumb when shopping for younger children, is to see if any pieces of the toy can fit into the tube of a roll of toilet paper. If so, then that toy is a choking hazard. She also points out that even small pieces that are attached to the toy can break off and become a choking hazard for a small child.

Avoid toys with:

  • Small parts
  • Sharp edges
  • Gears
  • Exposed wires
  • Hinges
  • Long strings
  • Magnets
  • Small batteries

2 – Is this toy developmentally appropriate for my child?

Dr. Coco also suggests parents only purchase age appropriate toys for their children. For instance, a bottle of bubbles or a paint set may be fun for an older child to play with, but each could be dangerous if consumed by a younger child. Be sure to read the labels on game and toys and adhere to the age recommendations listed.

3 – Is this toy age appropriate for my child?

The U.S. Consumer Product Safety Commission (CPSC) closely monitors and regulates toys. Any toys made in, or imported into the United States after 1995 must comply with CPSC standards. Remember parental supervision is always key around small children. Be careful that younger siblings don’t have access to toys belonging to their big brother or big sister.

Tips for parents with infants, toddlers and preschoolers:

  • Make sure toys are large enough that they can’t be swallowed (use the toilet paper roll test to be sure).
  • Toys should have soft, smooth edges and no sharp points. Toys should be safe enough to withstand chewing.
  • No strings
  • Avoid toys with batteries

By keeping these tips in mind, you can ensure the toys found under your tree will be safe and bring years of enjoyment to your child. For the latest information on toy recalls, check the CPSC website at www.cpsc.gov.

Not just the joints—treating Juvenile Arthritis

RavelliDr. Angelo Ravelli is considered an international expert in the field of pediatric rheumatology, which affects 50,000 kids across the country. An Italian native, he is traveling halfway across the globe to present his knowledge and research findings with the medical staff here at Children’s of Alabama. We asked Dr. Ravelli what he hoped to share with our clinicians that would in turn help the families they serve.
Here is what he had to say:

Q. What is the one thing you wish people outside of the medical field knew about Juvenile Arthritis?
A. In my view, people should know that although there has been an enormous progress in the care of children with JIA [Juvenile Idiopathic Arthritis] in the last decade and that frequency and severity of permanent disease-related damage has diminished markedly, this illness still causes a considerable burden to children and their families, owing to its protracted course, tendency to flare after treatment discontinuation, potential to induce pain and functional limitations and impact on quality of life related not only to clinical symptoms, but also to the need of long-term administration of medication therapies.

Q: What drew you to pediatric rheumatology?
A: I chose to join the general pediatrics residency program at the University of Pavia, Italy, in 1981, just when the rheumatology program was starting. I then became a pediatric rheumatologist by chance, because the chairmen of the Pediatric Department assigned me to that program. Then, I fell in love with this subspecialty and kept practicing it for the rest of my medical career.

Q. What is your biggest hope for parents and families who are dealing with JIA on a daily basis? Do you think that one day there will be a cure?
A: Nowadays we are able to reach remission or, at least, a satisfactory control of disease activity in most, if not all, children with JIA. In my opinion, the priority in daily clinical care of these patients is the ability to predict and prevent disease flares, which are quite common, particularly after treatment ends. I’m sure that one day there will be a cure for JIA. However, it is currently not possible to foresee when this will happen.

Q. Any comments on the Rheumatology program at Children’s of Alabama?
A. I know that the Rheumatology program at Children’s of Alabama is outstanding and is one of the most active and renown in the US. I know personally Drs. Cron and Beukelman, who are both internationally well recognized and respected authorities in the field. Dr. Cron is the co-principal investigator of the multinational project that has recently led to the development of the new classification criteria in systemic juvenile idiopathic arthritis. He has played and is still playing a fundamental role in ensuring the success of the initiative.

If you are interested in hearing Dr. Ravelli’s presentation, you can view the event live at noon on Thursday, Nov. 13 at http://www.childrensal.org/cme or watch the recorded version afterwards.

Kids, Flu and You: How to Prevent Viral Infection

By Rachel Olis

The start of a new school year brings excitement and anticipation of the year to come. Unfortunately, it also brings viruses (a type of germ) that can spread between children and cause sickness. Every year, 22 million school days are lost because of the common cold. Once a child is exposed to these germs, they can become infected by touching their eyes, mouth or nose. These infected children unknowingly continue to spread germs and infect more children. Viruses spread through the body quickly and cause sicknesses such as a cold and the flu. Antibiotics cannot treat these illnesses.

So what can parents do to minimize the risk of these viruses in children?

1- Prevent the spread of germs

“Helping to prevent the spread of germs and viruses is important in making sure that your child does not get sick,” said Brenda Vason, Manager of Infection Prevention and Control at Children’s of Alabama. Hand washing is the first line of defense. This simple practice protects against the spread of infectious germs. It is important that hand washing is performed properly to ensure that germs are scrubbed away.

To make sure your children are getting the most out of their wash:

  • Wash in warm water, but make sure that it isn’t too hot for little hands.
  • Use soap and lather for about 20 seconds. Make sure to get in between fingers and under the nails where germs like to hide.
  • Rinse and dry well with a clean towel.

Be sure that your children know to wash their hands before eating, after using the bathroom, after cleaning, after touching animals, after contact with someone who is sick, after sneezing or coughing or after being outside.

Getting a flu vaccination is another important way to keep from getting sick. The flu is a highly contagious virus of the respiratory tract. The flu vaccine does not cause the flu and keeps children and parents from getting sick. It is now recommended that everyone 6 months or older get the vaccine.

2- Be aware of signs and symptoms

Viral Infections can cause many symptoms that can differ from child to child. These symptoms can also change as the illness progresses.

Sometimes it can be difficult to determine if your child is experiencing a common cold or the flu. Typically flu symptoms present themselves suddenly and are more severe than a common cold. However, you should not brush these symptoms off. Symptoms, which normally begin about two days after contact with the virus, can include:

  • Fever
  • Chills
  • Headache
  • Muscle aches
  • Dizziness
  • Loss of appetite
  • Tiredness
  • Cough
  • Sore throat
  • Runny nose
  • Nausea or vomiting
  • Weakness
  • Ear pain
  • Diarrhea

3- Know when to call the doctor

For the most part, these viral infections will go away on their own with a little rest and relaxation. However, there are some cases that require medical attention. You should call the doctor if your child:

  • Has flu symptoms
  • Has a high fever or fever with a rash
  • Has trouble breathing or rapid breathing
  • Has bluish skin color
  • Is not drinking enough fluids
  • Seems very sleepy or lethargic
  • Seems confused
  • Has flu symptoms that get better, but then get worse

Children who are sick should stay home from school or daycare until their fever has been gone for at least 24 hours without the use of a fever-reducing medicine.

Scoliosis

By Rachel Olis

A little bit of curvature in the spine is completely normal. In fact, this curvature is necessary for us to balance, move and walk. But how much curve is too much?

Scoliosis is an abnormal curvature in the spine, often in the shape of a “C” or “S”. In these cases, there is too much curvature in the spine and may need treatment. Treatment options may include observation by a physician, wearing a back brace or surgery. Early detection is important in scoliosis patients, because when detected, early scoliosis can typically be treated with observation or a back brace. If left untreated, the spinal curve may become visible and cause pain or discomfort. At this point, the condition could begin to affect the lungs, heart and joints. In these advanced cases, spinal fusion surgery may be needed correct the problem. When treated properly, almost every child with scoliosis can have a healthy and active life.

Because early detection is so important, Alabama has implemented a law (Act No. 83-84) requiring public schools to examine students for the development of scoliosis. If there are positive results, a child is referred to a trained medical professional. These school screenings are meant to detect scoliosis at an age when the condition is mild and likely to go unnoticed.

“Early detection is key,” said Angela Doctor, R.N., Scoliosis Screening Coordinator at Children’s of Alabama. “Every child deserves an equal opportunity for early detection and treatment.”

While the cause of scoliosis is unknown, the condition can be hereditary and is much more likely to develop in girls. Signs of scoliosis normally appear between the ages of 10 and 14. Scoliosis happens gradually and does not usually cause pain, so it can be difficult to diagnose. So what should a parent do to make sure that their child’s spine is developing correctly?

 

  • Pay attention for signs of abnormal curvature. Some spinal curvature can be visible: the ribs are pushed out or one shoulder is noticeably higher than the other. 
  • Find out if your child’s school provides screenings and have your child participate. 
  • Have your child’s physician check for scoliosis during regular physical exams. Seeing a doctor is the most accurate way to diagnose. 

Usually, scoliosis is mild enough that it does not affect a child’s life and requires no medical treatment. Remember that early detection is important and have your children screened regularly.

Why Fever is Your Friend

By Rachel Olis

Many parents have experienced waking in the middle of the night to find your child flushed, hot, and sweaty. Your little one’s forehead feels warm. You immediately suspect a fever, but are unsure of what to do next. Should you get out the thermometer? Call the doctor? Visit an emergency room?

Fever occurs when the body’s internal “thermostat” raises the body temperature above its normal level. This thermostat is found in the part of the brain called the hypothalamus. to keep it that way.

In kids, fevers usually don’t indicate anything serious. Although it can be frightening when your child’s temperature rises, fever itself causes no harm and can actually be a good thing — it’s often the body’s way of fighting infections. And not all fevers need to be treated. High fever, however, can make a child uncomfortable and worsen problems such as dehydration.

“Fevers are the number one reason parents bring their child to the emergency room,” said Dr. Mark Baker, an Emergency Medicine Physician at Children’s of Alabama and Assistant Professor at UAB. “They account for 20 percent of all patient visits, and typically, can be treated at home.”

So how should you treat your child’s fever? When is it appropriate to seek medical attention? Here are three recommendations:

1 – Simply Monitor Your Child at Home

Kids whose temperatures are lower than 102°F (38.9°C) often don’t require medication unless they’re uncomfortable. There’s one important exception to this rule: If you have an infant 3 months or younger with a rectal temperature of 100.4°F (38°C) or higher, call your doctor or go to the emergency department immediately. Even a slight fever can be a sign of a potentially serious infection in young infants, Baker said or some other attribution needed.
The illness is probably not serious if your child:

  • is still interested in playing
  • is eating and drinking well
  • is alert and smiling at you
  • has a normal skin color
  • looks well when his or her temperature comes down

And don’t worry too much about a child with a fever who doesn’t want to eat. This is common with infections that cause fever. For kids who still drink and urinate normally, not eating as much as usual is okay.

2 – Contact your physician or visit and Emergency Room

In the past, doctors advised treating a fever on the basis of temperature alone. But now they recommend considering both the temperature and a child’s overall condition.

If your child is between 3 months and 3 years old and has a fever of 102.2°F (39°C) or higher, call your doctor to see if he or she needs to see your child. For older kids, take behavior and activity level into account. Watching how your child behaves will give you a pretty good idea of whether a minor illness is the cause or if your child should be seen by a doctor, says Baker.

Sometimes kids with fever breathe faster and may have a higher heart rate. You should call the doctor if your child is having difficulty breathing, is breathing faster than normal, or continues to breathe fast after the fever comes down.

The exact temperature that should trigger a call to the doctor depends on the age of the child, the illness, and whether there are other symptoms with the fever.

Call your doctor if you have an:

  • infant younger than 3 months old with a rectal temperature of 100.4°F (38°C) or higher
  • older child with a temperature of higher than 102.2°F (39°C)

Call the doctor if an older child has a fever of less than 102.2°F (39°C) but also:

  • refuses fluids or seems too ill to drink adequately
  • has persistent diarrhea or repeated vomiting
  • has any signs of dehydration (urinating less than usual, not having tears when crying, less alert and less active than usual)
  • has a specific complaint (e.g., sore throat or earache)
  • still has a fever after 24 hours (in kids younger than 2 years) or 72 hours (in kids 2 years or older)
  • has recurrent fevers, even if they only last a few hours each night
  • has a chronic medical problem such as heart disease, cancer, lupus, or sickle cell anemia
  • has a rash
  • has pain with urination

3 – Visit an Emergency Room

Seek emergency care if your child shows any of these signs:

  • inconsolable crying
  • extreme irritability
  • lethargy and difficulty waking
  • rash or purple spots that look like bruises on the skin (that were not there before the child got sick)
  • blue lips, tongue, or nails
  • infant’s soft spot on the head seems to be bulging outward or sunken inwards
  • stiff neck
  • severe headache
  • limpness or refusal to move
  • difficulty breathing that doesn’t get better when the nose is cleared
  • leaning forward and drooling
  • seizure
  • abdominal pain

Also, ask your doctor for his or her specific guidelines on when to call about a fever.

Keeping Kids Academically Active During Summer Break

By Rachel Olis

Going back to school isn’t always easy after a summer of relaxation and fun. Getting back into the habits of going to bed early and doing homework can be difficult. However, there are many ways that children can continue learning over the summer, and the transition back into “school mode” can be much more seamless.

“Playing is learning. Activities such as going to the zoo and museums, cooking, crafting and reading can all help children use the skills they already have to continue learning throughout the summer,” said Tara Motte, a teacher in Children’s Sunshine School.

The Sunshine School is a program at Children’s that helps patients stay on top of their schooling. It is staffed by six Alabama state certified teachers who all have the same goal of ensuring children stay educated and reach their highest learning potential despite their circumstances.

Even though students in the Sunshine School may continue their school work throughout the summer, it is important to keep all children’s minds active even when on summer break.

Fortunately, there are many ways to incorporate learning into everyday play time:

  • Take trips to the zoo, museums and library.
  • Use math skills by cooking and baking.
  • Do a science experiment.
  • On rainy days, use play dough to craft animals or make secondary colors.
  • Use some downtime each day to read for at least 15 to 30 minutes.
  • Limit screen time, including television, to an hour and a half and go outside instead!

Summer is also a time for travel and vacations, so use car rides as an opportunity to learn.

  • Use a standard deck of cards to play simple games like Go Fish and Crazy Eights, or even pack a set of trivia cards.
  • Give each child a journal and have them write down what they see along the way.
  • Play the Alphabet Game- pick any topic of interest and take turns naming something within that topic starting with the letter A, and so on.
  • Bring a large map and have the kids highlight and sticker all the different roads you take.
  • Have the children read. Bring the audio version as well so they can read along or listen if they get car sick.

The summer provides many opportunities for families to spend time together and have fun! However, it is important to ensure that children are keeping active physically and mentally throughout those weeks off.

Children’s expanding, improving services for children treated for cleft palates and lips

Dr. John GrantBy Dr. John Grant

During my first year at UAB and Children’s Hospital about 16 years ago, I performed about a half dozen operations to correct cleft lips and a couple of surgeries to correct cleft palates. Last year—along with my partner, Dr. Peter D. Ray—our team performed about 200 operations. This phenomenal growth in our clinic has been accompanied by improved quality.

We use advanced techniques along with a comprehensive team approach that provides care well beyond the operating room. For example, within the past decade, pediatric plastic surgeons have learned to correct underlying muscles in cleft lips and palates, thus providing a much more natural look and better speech for our patients. The face is dynamic, and these new techniques lead to a broader range of facial expressions and better speech control. Of course, we usually work with young patients, but there is an enormous opportunity to improve outcomes for older children and even adults who underwent cleft surgeries before these new techniques were widely used.

Due to our growth, Children’s now houses one of the nation’s busiest clinics for treating cleft lips and palates. We add about 150 new patients annually, and follow them through adolescence. We are excited about our upcoming move into larger quarters. The area that previously housed the emergency department in Children’s McWane Building has been renovated and will nearly double our space. We hope this makes us more efficient and enables us to shorten waits in our clinic for children and their families.

We already offer a full-service program that is staffed with experienced health care professionals, such as audiologists, speech-language pathologists and registered nurses as well as specialized physicians and dentists. They’ve seen hundreds of patients, and there’s a cumulative knowledge base. Our staff has realistic expectations about how children heal, how much pain they may or may not have and airway issues for babies versus adults.

We are excited about the launch of our new international fellowship program. For many years, American doctors have traveled to developing countries where they quickly perform operations for cleft palates and lips. Unfortunately, there is often a lack of follow-up care, and many patients go untreated. We want to educate doctors from these countries so they can establish their own full-service clinics that will provide more thorough and consistent care. The first fellow will be coming this summer from Ghana, West Africa, for 11 months of training, and another will come next year from Egypt. We are hopeful that they will become the teachers for the next generation of doctors in their countries and make it possible for children in those places to have full-time, quality follow-up and coherent planning, instead of care based on chance.

Additionally, we are improving our techniques for conditions other than cleft lips and palates. One service line we want to increase is a technique called tissue expansion. It’s been used a lot in secondary burn reconstruction. But we are also using it for children with giant congenital nevus, or dark patches of skin, often on the face or scalp. We surgically place flat balloons under adjacent, normal skin, and families are taught to slowly inflate these balloons over weeks so a child’s skin is stretched. Then, the patient returns to the hospital for an operation that utilizes the stretched skin to replace discolored skin, restoring normal tissue. We have enhanced this service line with the help of Dr. Bruce S. Bauer of Chicago, a pediatric plastic surgeon who is renowned for his refinement and application of this technique. It’s low risk for the patient and requires little time in the hospital.

All this work is extremely rewarding for our team. Seeing families get their babies back after a cleft operation is an occasion that many parents tell us is nearly as joyful as giving birth.

 

Preventing noise-induced hearing loss

By Rachel Olis

Loud volumes on iPods, cell phones and other personal devices are contributing to an increase in the number of children, teens and adults that suffer from noise-induced hearing loss (NIHL) each year. Hearing loss is the third most common health problem in the United States and affects over 36 million Americans.

“Hearing loss in children has become a serious problem,” said Heather Baty, audiologist at Children’s of Alabama. “It is critical to a child’s safety and to the development of many social skills, speech and learning.”

According to the American Speech, Language and Hearing Association, almost 12 percent of all children between the ages of 6-9 have noise-induced hearing loss (NIHL).

Part of the inner ear, called the cochlea, contains tiny hair cells that send sound messages to the brain. However, once the hair cells within the cochlea are damaged, they cannot grow back, making the damage permanent. A hearing test is often necessary to detect NIHL because many people are not aware of the loss. Children rarely complain about the symptoms of NIHL which include distorted and muffled sounds that make understanding speech more difficult.

Fortunately, noise-induced hearing loss is 100 percent preventable. Here are some ways to prevent NIHL:

  • Turn it down- a very simple way to prevent NIHL is to turn down the volume on iPods, cell phones, the television and the radio. Keep the volume at no more than 60 percent, or at normal conversation volume. Also, being able to hear music outside of the headphones is a sure sign that the volume is too loud and hearing is being affected!
  • Limit listening time- another easy way to prevent NIHL is to limit the amount of time with ear buds in. A good rule is the 60percent/60-minute rule. Keep the volume at 60 percent for no more than 60 minutes.
  • Use hearing protection- ear muffs are often less damaging than ear buds, but both can be dangerous when not used in moderation. Fortunately, both are available with features that promote safe hearing. Also, wear earplugs at concerts and places where the noise will be damaging.

April is National Child Abuse Awareness Month

By Rachel Olis

Child abuse is more than bruises and broken bones. While physical abuse might be most visible, other types of abuse, such as emotional abuse or child neglect, also leave deep, long lasting scars. Some signs of child abuse are subtler than others. Since April is National Child Abuse Awareness Month, the experts at Children’s of Alabama want to remind you of the importance of recognizing and reporting abuse of any kind.

“By learning common types of abuse and what you can do, you can make a huge difference in a child’s life,” says Deb Schneider, director of Children’s Hospital Intervention and Prevention Services, or the CHIPS Center at Children’s of Alabama. “The earlier abused children get help, the greater chance they have to heal from their abuse and not perpetuate the cycle.”

The four types of child abuse are:
• Physical Abuse
• Sexual Abuse
• Emotional Abuse
• Neglect

In Alabama, one in six kids are physically abused every year and as many as 25 percent of children will be sexually abused by the time they reach age 18. Physical abuse is the leading cause of death under the age of 3.

Neglect remains the highest reported form of abuse in our state.

The signs of child abuse vary depending on the type of abuse, but there are some common indicators:

Warning signs of emotional abuse in children:
• Excessively withdrawn, fearful or anxious about doing something wrong.
• Shows extremes in behavior (extremely compliant or extremely demanding; extremely passive or extremely aggressive).
• Doesn’t seem to be attached to the parent or caregiver.
• Acts either inappropriately adult (taking care of other children) or inappropriately infantile (rocking, thumb-sucking, tantrums).
Warning signs of physical abuse in children:
• Frequent injuries or unexplained bruises, welts, or cuts.
• Is always watchful and “on alert,” as if waiting for something bad to happen.
• Injuries appear to have a pattern such as marks from a hand or belt.
• Shies away from touch, flinches at sudden movements, or seems afraid to go home.
• Wears inappropriate clothing to cover up injuries, such as long-sleeved shirts on hot days.

Warning signs of neglect in children:
• Clothes are ill-fitting, filthy, or inappropriate for the weather.
• Hygiene is consistently bad (unbathed, matted and unwashed hair, noticeable body odor).
• Untreated illnesses and physical injuries.
• Is frequently unsupervised or left alone or allowed to play in unsafe situations and environments.
• Is frequently late or missing from school. Read more

National Poison Prevention Week: Danger of Disc Batteries

disc_batteriesBy: Ann Slattery, DrPH, RN, RPh, CSPI, DABAT, Managing Director, Regional Poison Control Center at Children’s of Alabama

There are many objects throughout a household that children can swallow, but one particular object that has warranted many calls to the Regional Poison Control Center at Children’s of Alabama (RPCC) are disc batteries, which can easily be mistaken for a quarter or other coins. The RPCC at Children’s of Alabama has received 60 exposure calls related to disc batteries in the last three years with no fatalities.

Disc batteries are round flat batteries that range in size from a pencil eraser to a quarter (5 mm – 20 mm) that are used in watches, calculators and hearing aids. The majority of exposures to disc batteries occur in curious children.

From 1985-2009, 56,535 disc battery ingestions were reported to the National Poison Data System. Fortunately, deaths after swallowing a disc battery are rare, less than 0.02 percent. However, these ingestions are serious, so it is important to be aware of the symptoms of possible poisoning. These symptoms include cough, wheezing, irritability, poor appetite, vomiting, lethargy, fever and dehydration.

More often than not, the caregiver did not see the ingestion of the disc battery, but if a disc battery is swallowed, an X-ray is needed to find its location in the body. Only then can appropriate recommendations be made.

  • If the battery has moved beyond the esophagus, most will pass uneventfully through the rest of the digestive system and pass within a matter of few days.
  • If the battery is lodged in the esophagus, it is considered an emergency and requires immediate removal.
  • A disc battery becoming lodged beyond the esophagus is unlikely, but if it happens, burns may occur resulting in tissue damage and internal bleeding, causing in a medical emergency.

The majority of disc battery ingestions occur immediately after the battery is removed from the object, but discarded or loose batteries also account for a fair amount of ingestions. It is very important to keep disc batteries out of reach and out of sight!

National Poison Prevention Week is March 16 – 22, 2014. The themes are “Children Act Fast…So Do poisons!” and “Poisoning Spans a Lifetime.” While pediatric (less than 6 years of age) exposures account for 52 percent of The Regional Poison Control Centers (RPCC) at Children’s of Alabama human exposures; adults also experience poisoning with adult exposures accounting for 32 percent of the call volume.  The RPCC received 37,842 calls in 2013 including more than 24, 000 human exposures with more than 44,000 follow up calls. In 2014 the RPCC expects to receive 58,000 calls with 38,000 human exposures. The RPCC is available 24/7 at 1-800-222-1222.

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